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Referencing for anterior atlantoaxial trans-articular osteosynthesis: a radiological study and proposal of a decisional algorithm

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Abstract

Purpose

Anterior trans-articular C1–C2 screw placement can be considered as a surgical alternative in different conditions affecting the atlantoaxial region. While its rigidity is similar to posterior Magerl and Harms techniques, it also provides some surgical advantages. However, the literature lacks papers exhaustively describing indication criteria, surgical steps, and pitfalls.

Methods

This is a radiological study on 100 healthy subjects. Thin-layer CT scans of the craniovertebral junction were retrieved from the institutional database. The coronal inclination of the C1–C2 joint rim and the depth of the entry point of the screw with respect to the anterior profile of C2 were measured. The antero-posterior and the medio-lateral surgical corridors for the screw placement, and the wideness of the target area on the upper surface of C1 were also measured.

Results

The multivariate analysis showed that the coronal inclination of the C1–C2 articular joint rim strongly influences the surface extension of the C1 target area; the depth of the entry point and the C1–C2 articular rim inclination seem to be independent factors in influencing both the medio-lateral and the antero-posterior surgical corridors wideness. A decisional algorithm on whether to perform an anterior or posterior approach to the atlantoaxial region was also proposed.

Conclusions

We can conclude that, as much as the C1–C2 articular rim is tending to the horizontal line, and as deeper is the entry point of the screw on the anterior profile of C2, as easier the anterior C1–C2 trans-articular screw placement will result.

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Funding

This research received no external funding.

Author information

Author notes

  1. Massimo Miscusi and Luca Ricciardi have contributed equally to the present paper.

Authors and Affiliations

  1. UOC di Neurochirurgia, Department of NESMOS, Sapienza University, Rome, Italy

    Massimo Miscusi, Luca Ricciardi, Amedeo Piazza, Mattia Capobianco, Michele Acqui, Sokol Trungu & Antonino Raco

  2. UOC di Neurochirurgia, Ospedale M. Bufalini, Cesena, Italy

    Giorgio Lofrese

  3. UO di Neurochirurgia, AO Cardinal G. Panico, Via Fratelli Peluso 8, Tricase, 73039, Italy

    Sokol Trungu

Authors
  1. Massimo Miscusi
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  2. Luca Ricciardi
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  3. Amedeo Piazza
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  4. Mattia Capobianco
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  5. Giorgio Lofrese
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  6. Michele Acqui
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  7. Sokol Trungu
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  8. Antonino Raco
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Contributions

MM contributed to conceptualization, methodology, writing—original draft preparation, writing—reviewing and editing. LR contributed to conceptualization, writing—reviewing and editing, formal analysis, data curation. AP contributed to data curation, writing—original draft preparation. MC contributed to investigation, visualization. GL contributed to software, investigation, visualization. MA contributed to formal analysis, data curation. ST contributed to validation, supervision. AR contributed to writing—reviewing and editing, supervision.

Corresponding author

Correspondence to Sokol Trungu.

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Supplementary Information

Below is the link to the electronic supplementary material.

3D printable model of the atlantoaxial complex, entry points, and the working corridors for screws placement (MP4 8174 kb).

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Miscusi, M., Ricciardi, L., Piazza, A. et al. Referencing for anterior atlantoaxial trans-articular osteosynthesis: a radiological study and proposal of a decisional algorithm. Eur Spine J 31, 3410–3417 (2022). https://doi.org/10.1007/s00586-022-07380-y

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  • DOI: https://doi.org/10.1007/s00586-022-07380-y

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